See both financial advisor and elder law lawyer for Mom?

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Gambler
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See both financial advisor and elder law lawyer for Mom?

Post by Gambler »

dad died a couple of months ago.

I want to make sure Mom's financial house is in order so I'm going to make an appt for an independent financial advisor.

But she's also thinking about nursing homes and how to reduce her assets to qualify for Medicaid.
she's 64 and has arthritis. she's fine now but is thinking next decade.

She owns a $700k house (paid for), has $300k from dad's 401k and $300k from dad's employee stock purchase plan (non-401k) which she hasn't sold yet.
Combined pension (her's and dad's), and dad's social security (when she turns 65 for FRA) = $6k/month.
her expenses are like $3k/month.

the thought of Trust comes to mind and that means lawyer?

So I need to start researching elder law lawyers too?


Edit:
She lives in NYC

edit2:
now mom is talking about pooled trust (www.ohelfamily.org and www.nysarc.com)??? she got the idea from one of her church friends. :oops:

and the lawyer she found cost $5000 to make a trust. :shock:
Last edited by Gambler on Sat Oct 11, 2014 1:13 pm, edited 3 times in total.
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ixohoxi
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Re: See both financial advisor and elder law lawyer for Mom?

Post by ixohoxi »

What state does she live in?
Federal estate tax, and many states, don't impose estate taxes for estates smaller than 5.25MM. So a trust is probably not necessary.
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bluemarlin08
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Re: See both financial advisor and elder law lawyer for Mom?

Post by bluemarlin08 »

Why does she want to voluntarily choose to go on Medicaid? Her choices for doctors under Medicaid are very limited and often with doctors that are undesirable.
Gill
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Re: See both financial advisor and elder law lawyer for Mom?

Post by Gill »

She's worth $1,300,000 and has an income in addition to that of $72,000 and desires to qualify for Medicaid? You might both seek other interests to pursue.
Gill
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epitomist
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Re: See both financial advisor and elder law lawyer for Mom?

Post by epitomist »

I'm sorry to hear about your father. That is a tough thing for you and your mom to go through.

[OT comments removed by admin LadyGeek]

I think you are correct that you want to speak to a financial advisor and elder law attorney. The biggest thing in your favor though is that your mother is thinking ahead about this. Many parents choose not to think about this and their decision is made for them after they wait too long. Parents who do think about this often start giving money to their heirs on a regular basis now with the timetable you've outlined.
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BL
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Re: See both financial advisor and elder law lawyer for Mom?

Post by BL »

First Google your state's Medicaid income limits and asset limits. My guess is that the income would be too high, as well as the assets.
dad's social security (when she turns 65 for FRA) = $6k/month.
FRA hasn't been age 65 for a decade, so it is probably close to 66.
She can draw on hers now and switch to survivor at FRA, if that is larger than hers at age 70, which is another set of options.

She may want to get new beneficiaries and find out about time limits and methods for changing titles to property.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by Pizzasteve510 »

Edit. Off topic.
Last edited by Pizzasteve510 on Mon Sep 29, 2014 9:53 am, edited 1 time in total.
songman52
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Re: See both financial advisor and elder law lawyer for Mom?

Post by songman52 »

I agree with Gill. With that much income your mom should be able to afford a high quality of care, if the time comes that she needs it. In Texas, she would have to keep her assets below $2100 and she would be allowed to keep $60 per month of income (and don't let it accumulate to take the assets over the $2100 limit!) The rest of the income would be payable to the nursing facility. Earlier this year we went through this process with my mother. She had to spend down her assets (approximately $28K) to below the limit and of her $1300 monthly income she keeps $60 and the rest pays the nursing home. AND the "spend down" money had to be for her benefit - no gifts, bequests, etc. She was not even allowed to give a gift to her new great-grandchild. So she (we) got a nice piece of furniture for her room, prepaid most of her burial expenses, and bought her some personal items, including some clothes. BTW, most of the assets she had to spend were from cashing in a life insurance policy she had hoped to use for final expenses and leave a little to her kids. Medicaid law required her to take out the cash value (surrender the policy) and spend it down. A few thousand went to pay an elder law attorney to take care of all of this. My mother is now in a facility that is supposed to be one of the better ones in our area, but if she had the income or assets of Gambler's mom, there is no way she would be in a Medicaid eligible facility. There are a few VERY NICE facilities in the area, but they are private pay only. There IS a huge difference, personnel being the biggest determinant of her level of care. Oh, and don't forget about the five year "look back" period for disposing of assets. Yes, consult an Elder Law specialist before you do anything.
technovelist
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Re: See both financial advisor and elder law lawyer for Mom?

Post by technovelist »

epitomist wrote:I'm sorry to hear about your father. That is a tough thing for you and your mom to go through.

[OT comments removed by admin LadyGeek]

I think you are correct that you want to speak to a financial advisor and elder law attorney. The biggest thing in your favor though is that your mother is thinking ahead about this. Many parents choose not to think about this and their decision is made for them after they wait too long. Parents who do think about this often start giving money to their heirs on a regular basis now with the timetable you've outlined.
No, what you are "supposed to do" is to spend your own money on your own care. I'm not sure why this is controversial. :confused
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ralph124cf
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Re: See both financial advisor and elder law lawyer for Mom?

Post by ralph124cf »

Your mother is in the zone where a LTC policy makes financial sense.

She has too much income and assets to reasonably qualify for state assistance with nursing home care, but not enough to self insure for care that is now approaching $10,000/month.

See the elder law attorney first, and certainly before taking any action based on what a financial adviser may say. Many financial advisers tell you to do what is in the advisers best interest instead of your best interest.

Ralph
epitomist
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Re: See both financial advisor and elder law lawyer for Mom?

Post by epitomist »

technovelist wrote:
epitomist wrote:No, what you are "supposed to do" is to spend your own money on your own care. I'm not sure why this is controversial. :confused
Yes, I'm supposed to spend my own money on my own care. [OT comments removed by admin LadyGeek]

Regarding the OP's problem, the advice from ralph124cf and songman52 seem spot-on. I agree that your mom is not likely to qualify for Medicaid except in a catastrophic situation. Preparing now could lessen her financial burden in the event that happens, either in the way of LTC insurance or gifting assets a decade or more before the catastrophe happens.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by bluemarlin08 »

I can't imagine any sane person that would choose to go on Medicaid. Check with her current doctors and see which ones will accept Medicaid. I've seen it first hand and her options are limited, just read an article yesterday that showed how Medicaid patients were having to wait months for appointments and often had to travel great distances. Medicaid is there as a safety net for the poorest of the poor, certainly one can game the system, for the benefit of the heirs.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by ddunca1944 »

bluemarlin08 wrote:I can't imagine any sane person that would choose to go on Medicaid. Check with her current doctors and see which ones will accept Medicaid. I've seen it first hand and her options are limited, just read an article yesterday that showed how Medicaid patients were having to wait months for appointments and often had to travel great distances. Medicaid is there as a safety net for the poorest of the poor, certainly one can game the system, for the benefit of the heirs.
+1
My granddaughter (disabled) is on Medicaid. It took months to find an endocrinologist who accepted Medicaid patients.
The dr is a longways away and a single appointment takes a full day to drive there and back.

My mother is in a Medicaid facility. She is simply warehoused there. She gets the basic bed, food and minimal medical care. I will do everything in my power to avoid ending up in a place like that.
I suspect people like the OP's mother are clueless about the reality of beingon Medicaid.

Because so many people ARE -legally- gaming the system, I expect the requirements will becomeeven more stringent than they already are.
Mitchell777
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Re: See both financial advisor and elder law lawyer for Mom?

Post by Mitchell777 »

When someone pays down all their assets in a nursing facility and then goes onto Medicaid, do they automatically go onto Medicaid for health insurance? Even if they have retirement health insurance (Medicare Advantage for example), mostly paid by their former employer? Also can they keep any money to pay for misc items like clothing etc. I'm thinking of a parent that has SS and a small pension and is paying down personal assets currently
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Re: See both financial advisor and elder law lawyer for Mom?

Post by celia »

epitomist wrote:[OT comments removed by admin LadyGeek]
Epitomist, Why do you work hard and save? For your future care? Or for your legacy? Do you hope to go on Medicaid?

I would much rather my parents paid for their own care as much as possible instead of giving me their "excess money" and I have to use it later on to help care for them. (Meanwhile, I may spend it.) I think the same in regards to my kids. We don't want to rely on them HAVING to support us. It's hard enough for them to support themselves these days.

OP, Why don't you take your mom to visit a Medicaid nursing home and a nice non-Medicaid home. See which type of environment she likes. This will save time later on when she has no choice that she has to go to a nursing home. What you would be trying to do (besides help her see what Medicaid covers) is helping her pick a nursing home now so that months before she actually needs it, she can be put on a waiting list.

Would she like a room to herself? Would she like group outings? Social interaction/in-house activities like crafts, singing, playing cards? Is it near the things she needs (doctors, church, friends, favorite restaurant, organizations she may belong to)? Would she like a nice view? Get her thinking about what she would have to give up besides money if she went on Medicaid. (I find it depressing when I go into a group home and the residents are watching TV all day.)
Last edited by celia on Mon Sep 29, 2014 1:12 pm, edited 2 times in total.
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epitomist
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Re: See both financial advisor and elder law lawyer for Mom?

Post by epitomist »

celia wrote:
epitomist wrote:[OT comments removed by admin LadyGeek]
Epitomist, Why do you work hard and save? For your future care? Or for your legacy? Do you hope to go on Medicaid?
As I said, I don't know a lot about this topic because it frankly doesn't have a chance of pertaining to me for decades if at all. For my parents, my mother died relatively young (59) and my father has a net worth on par with a frugal fast food worker. My own net worth is more than the OP's mother, so not much chance of me having to even make the decision at any point.
celia wrote:I would much rather my parents paid for their own care as much as possible instead of giving me their "excess money" and I have to use it later on to help care for them.
Great for you! My only objection is the frequent lecturing of "pay your bills, deadbeat" that goes on here.

If someone wants to lawfully arrange their finances to make it possible to go on Medicaid, it is not morally wrong. At least, it's no more wrong than lawfully arranging your finances to avoid or postpone paying taxes.

The argument others are bringing up (i.e. "Medicaid stinks") are valid arguments. [OT comments removed by admin LadyGeek]
Mitchell777
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Re: See both financial advisor and elder law lawyer for Mom?

Post by Mitchell777 »

The Medicaid discussion, and I’ll try to keep it financially oriented to some extend, may differ by area/state. Many people private pay for a considerable period of time but still end up on Medicaid. The question is did you have enough private pay money to enter a well-rated facility where they will then keep you once you must go on Medicaid. In my area that can be 2+ years of private pay. I’m familiar with a facility recommended by my elder law attorney. I’m sure some of the people are on Medicaid, others on private pay, still others from their continuing care/residential facility. I can’t tell which are which. There is no wing where they move people when their private-pay money runs out. What I am almost sure of is that no one there entered when it was known they were going right into Medicaid or onto Medicaid in several months. The 3 top rated facilities recommended by my attorney are all non profits, two faith based. One has no private rooms. Another told me it is almost impossible to get one there are so few. But that is changing as they see the demand, and you need the private pay to have that opportunity. I’m not saying this is the case everywhere. I realize this is one of those emotional topics and that everyone has had different experiences.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by gougmonk »

My two cents on this thread as I understand it's content.

Sorry, but it is morally wrong to hide a parents savings and then expect the tax payer to fund the parents nursing home expenses. It is not morally wrong to spend down saving on ones care then apply and accept Medicaid assistance, that what Medicaid is for.

Years ago I enjoyed a radio talk host, I believe his name was Bruce Williams. More than once a caller asked how to hide a relatives savings in order for the relative to qualify for Medicaid. Bruce lectured the miscreant that it is morally wrong to game the system in order qualify for assistance, "qualify for assistance" being another phrase for "steal from the tax payer". This is not equivalent to utilizing a 401k or IRA to minimize taxes.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by b4real »

Gambler,
My mother is in a non-medicaid nursing home. My sister in law's mother is in a medicaid nursing home. The differences between the two facilities could not be starker. My sister in law's mother would not be in the medicaid facility if she had a choice. Your mother can afford to self pay a good nursing home for many, many years if the need arises. I would urge her and you to visit some medicaid and non-medicaid facilities in your area before she decides on medicaid.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by Gnirk »

b4real wrote:Gambler,
My mother is in a non-medicaid nursing home. My sister in law's mother is in a medicaid nursing home. The differences between the two facilities could not be starker. My sister in law's mother would not be in the medicaid facility if she had a choice. Your mother can afford to self pay a good nursing home for many, many years if the need arises. I would urge her and you to visit some medicaid and non-medicaid facilities in your area before she decides on medicaid.
+1
pshonore
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Re: See both financial advisor and elder law lawyer for Mom?

Post by pshonore »

I believe once a person turns 65, the only Medicaid available is for nursing homes and other custodial care. They are still covered by Medicare (assuming they're eligible) for most medical problems and can see any doctor who accepts Medicare. If they are low income and qualify , I believe Medicaid or the State equivalent will pay the Part B premiums, provide prescriptions and limited Medigap insurance for deductibles, co-pays, etc.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by Minot »

I don't think I would feel good about ending up with the money my Mom gifted me or tucked away in a trust for me to inherit if it meant she spent the last few years of her life in a Medicaid facility. I really would prefer that she use that money to make those years better for herself.
Last edited by Minot on Mon Sep 29, 2014 3:17 pm, edited 1 time in total.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by ddunca1944 »

Gnirk wrote:
b4real wrote:Gambler,
My mother is in a non-medicaid nursing home. My sister in law's mother is in a medicaid nursing home. The differences between the two facilities could not be starker. My sister in law's mother would not be in the medicaid facility if she had a choice. Your mother can afford to self pay a good nursing home for many, many years if the need arises. I would urge her and you to visit some medicaid and non-medicaid facilities in your area before she decides on medicaid.
+1
+2

I did not work and save all my life to spend my last years on welfare.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by songman52 »

Medicaid is state-specific; it is jointly funded by the federal and each state government and administered by each state. It is an entitlement program, not limited to any particular number of recipients. If one meets the eligibility requirements, they get the benefits.
Mitchell777 said
When someone pays down all their assets in a nursing facility and then goes onto Medicaid, do they automatically go onto Medicaid for health insurance? Even if they have retirement health insurance (Medicare Advantage for example), mostly paid by their former employer? Also can they keep any money to pay for misc items like clothing etc. I'm thinking of a parent that has SS and a small pension and is paying down personal assets currently
Again, In Texas, one must apply for Medicaid, it is not automatic. Some nursing homes will help fill out the paperwork, though this can be problematical in that the helper might not know all the nuances of the Medicaid law. Once eligible, therefore approved, the recipient cannot keep more than about $2100 plus certain assets like one vehicle and a home. In my mother's case she lived in an apartment before needing nursing home care, and had quit driving several years earlier and had no vehicle. She receives a small pension from the US Government, SS, and a pension from her years of employment. Medicaid allows her to keep $60 per month and the rest is the reimbursement rate to the nursing home. Any clothes or misc. items she buys comes from the $60 monthly or her bank account (which, again, can not exceed @ $2100.)She pays a small monthly amount for dental insurance. Thank heavens she is covered by Tricare. In any month which her account balance (and any other money she has) should exceed the $2100 limit on the last day of the month, she will be ineligible for Medicaid. She would have to spend down and then apply for re-instatement.
I hope this helps answer your question. As others have said, Medicaid is for the poor/needy. Also, in our area, the really nice facilities are private pay only. Those which accept Medicaid tend to be understaffed and the level of care is much less. It is the main reason we visit daily, to "remind" staff of things they are supposed to be doing, and keep watch over my mother and her roommate. It's a shame it's that way. Unfortunately my siblings and I don't have the resources to pay for better care (private pay), and my mother needs the medical care we could not provide in our home(s). I don't begrudge the taxes and Medicaid; I am sincerely thankful the safety net exists.
Edited for spelling.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by kDictavissent »

My late mother required in-home care the last eighteen months of her life. She had enough assets that she could afford to pay the expense herself, and while you could have looked at it as "eating up" her assets, she and I both felt very fortunate that she could afford to be a private-pay patient. I got glimpses of the care that state Medicaid patients received and she clearly was able to afford a higher level of care including paid aides living at home around the clock.

If she had survived another... seven or eight years?... she would have exhausted her resources and had to have gone on Medicaid. That would have been okay with me at that point if I could have done nothing to have prevented it, but I imagine my and my wife's income would have tried to pay for services as long as we could have.

OP, slightly off topic but you might consider for yourself and your family the benefits of LTC insurance. We bought LTC when we were (very) young ... probably too young, but my wife's family has a history of health problems in their 40s and it gives my wife great peace of mind. We pay about $150 per month for both of us to have LTC insurance that is inflation-indexed and generous for when we need it decades from now. This won't help with your mother, but consider doing it for yourself and your family. Not enough of us who are younger take time to research and invest in these products.
epitomist
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Re: See both financial advisor and elder law lawyer for Mom?

Post by epitomist »

gougmonk wrote:Years ago I enjoyed a radio talk host, I believe his name was Bruce Williams. More than once a caller asked how to hide a relatives savings in order for the relative to qualify for Medicaid. Bruce lectured the miscreant that it is morally wrong to game the system in order qualify for assistance, "qualify for assistance" being another phrase for "steal from the tax payer". This is not equivalent to utilizing a 401k or IRA to minimize taxes.
[OT comments removed by admin LadyGeek]
Mitchell777
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Re: See both financial advisor and elder law lawyer for Mom?

Post by Mitchell777 »

Songman Thanks. A couple helpful bits of info for my situation in your post. It does vary by area. In my area and the next county over almost none of the facilities are private pay only. The better ones accept Medicaid but only if you have private pay for 2+ years. The one I'm aware of with private pay only has a great reputation but only the wealthy in the area can afford it. We have some of the highest nursing home costs in the country. The better 3 in my county all charge just shy of $10K per month for a semi room with laundry, meds etc all extra. It is true you must visit regularly. Weekends and holidays have part time people that often are not familar with the patients. There are sometimes not enough of them at times like morning and bedtime. The Medicaid payment to the facility is about 60% of private pay as I understand. I think when the time comes to apply for Medicaid I may seek assitance out side of the facility as I'm not real comfortable with the Admissions head.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by Gnirk »

With the OPs mother's level of income, she might wish to explore an alternative to SNF/Medicaid if/when she needs care. In our area, and many others, there are Adult Family Homes, licensed by the state to provide 24 hour care. It is less expensive than the nursing homes in our area.Some, as the one my mother is in, specialize in dementia care. My mother's retirement incomes/SS has been enough to pay for the top-notch, almost one-to-one care she receives. We have not had to touch her investments yet, though if the costs increase, we will. But then, that's what they are there for. She also had LTCI, which covered four years, and will make the final payment this month.

This is her 7th year in the home. It is licensed for three residents, and the owner/caregiver provides the best personal care I could imagine.
Even if mom didn't have LTCI, we would have done everything to keep her here. It is private pay only. I am so thankful my mom was frugal throughout her life.
You don't find this type of care in Medicaid facilities, or even in most SNF, private pay or not.

She will be able to stay here through end of life, and just recently qualified for Hospice care. In her case, Hospice provides weekly nurse visits and the medications and supplies for comfort care, while her caregiver still provides the hands-on daily care.
Last edited by Gnirk on Mon Sep 29, 2014 7:30 pm, edited 1 time in total.
adamthesmythe
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Re: See both financial advisor and elder law lawyer for Mom?

Post by adamthesmythe »

> Legally and morally,

I submit that legal is not the same as moral. Maybe because I am in a professional field- I hold myself to a higher standard than avoiding behavior that could land me in jail.

There are two aspects of morality here. One is attempting to take advantage of programs meant for the poor while being comparatively well off. The other aspect is allowing or encouraging a parent to have a lower quality of life or lower standard of care than that she can afford. I think the second may be more dishonorable.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by Jack FFR1846 »

Just some points of information (I would preach, but I never went to preacher school). My wife's aunt was in a horrible accident and following ICU and Hospital went to a private pay nursing home in Worcester, Ma. As my wife and I had taken over her affairs, I know that this cost $10k per month and was partly paid by insurance and partly private pay. As she improved, she went into a private rest home (less skilled care than nursing home) and was there for several months at $6k per month. The policy at the rest home was that after 2 years of private pay, they would accept whatever income came. She was on a state pension of $21k per year. This was a nice facility.

Her costs overall for 6 months between all of this that wasn't covered by insurance was about $120k.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by LadyGeek »

Please stay on topic, which is a question on the need of both a financial advisor and elder law attorney.
Gambler wrote:dad died a couple of months ago.

I want to make sure Mom's financial house is in order so I'm going to make an appt for an independent financial advisor.

But she's also thinking about nursing homes and how to reduce her assets to qualify for Medicaid.
she's 64 and has arthritis. she's fine now but is thinking next decade.

She owns a $700k house (paid for), has $300k from dad's 401k and $300k from dad's employee stock purchase plan (non-401k) which she hasn't sold yet.
Combined pension (her's and dad's), and dad's social security (when she turns 65 for FRA) = $6k/month.
her expenses are like $3k/month.

the thought of Trust comes to mind and that means lawyer?

So I need to start researching elder law lawyers too?
Sorry for your loss. I also lost my Dad a few months ago. I think you want to work with both an elder law attorney and a Financial planner (not investment advisor).

You need to update the will, advanced health care directive ("living will"), power of attorney, medical power of attorney. If something bad happens, who will take care of the financial needs (as well as medical)?
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Re: See both financial advisor and elder law lawyer for Mom?

Post by arcticpineapplecorp. »

Mitchell777 wrote:When someone pays down all their assets in a nursing facility and then goes onto Medicaid, do they automatically go onto Medicaid for health insurance? Even if they have retirement health insurance (Medicare Advantage for example), mostly paid by their former employer? Also can they keep any money to pay for misc items like clothing etc. I'm thinking of a parent that has SS and a small pension and is paying down personal assets currently
Medicaid is the payer of last resort. This means that Medicaid only pays for medical expenses not covered by primary or secondary insurance. So if you have employer insurance, that is usually primary, Medicare secondary, Medicaid tertiary. If you don't have employer provided coverage, Medicare is primary, Medigap, supplemental Medicare coverage (plan C or other) is secondary, and Medicaid is tertiary. Not everyone has supplemental Medicare coverage. In those cases Medicare is primary and Medicaid is secondary.

When you go on Medicaid, you can keep your other insurance (employer provided or Medicare supplemental) and the premium gets subtracted from your cost of care. In other words, there's no financially beneficial reason to drop other coverage because you qualify for Medicaid for Long Term Care. If you cancel the other insurance, the premium you would have paid would be payable to the nursing home towards your cost of care. Paying for the additional insurance means you get to keep the money that would go towards your cost of care...but you keep it only so you can pay your premium. In effect, the State subsidizes the health insurance premium for those on Medicaid with other insurance because the State now pays that money to the nursing home for the cost of care that otherwise the person would have and pay themselves. Why does the State prefer to pay the money to the nursing home that the client gets to keep to pay their employer paid/medicare supplemental insurance? Because having other insurance reduces the amount the State has to cover for medical costs. The State subsidizing the client's insurance premium is most likely cheaper than paying the medical bills that would incur if the client didn't have other insurance coverage.

That being said, while Medicare does cover some medical costs, they do not cover room and board coverage for long-term stays. They usually cover 100% of the first 20 days if short term (6 months or less) and around 80% up to the next 80 days. So some of the first 100 days might be covered, but only if you're in skilled care for rehab and expected to leave within 6 months. And even then, not all of it.

As another said, Medicaid is not automatic, it requires an application and eligibility. Public Welfare, is an eligibility program, not an entitlement program. Social Security is an entitlement program, not an eligibility program.

In terms of keeping money to pay for clothing, etc...most states allow a client to keep $45 from their income, though another poster said Texas allows $60. The rest of the monthly income is paid out between medical insurance costs (med part b deduction, supplemental insurance) and the client's cost of care. A person can use the $45 each month they retain from their income in any way they want. A client can also keep a certain amount of resources, usually either $8000 or $2400 depending on whether their income is less than or more than $2163, respectively (I believe in PA anyway) and that $8000 or $2400 is there's to use for clothing, etc. (but not for gifting).

Finally, one person talked about Medicaid requiring cashing out of a life insurance policy. This isn't always the case. However, if the cash value after a $1000 exemption plus all other resources exceeds the $8000 or $2400 resource limit, then life insurance could have to be either cashed out, or cash value borrowed (and spent on medical bills or irrevocable burial or to the nursing home) to reduce resources to the Medicaid limit. In other cases, even if the cash value exceeds the Medicaid resource limit, it is possible to irrevocably assign the life insurance policy to a funeral home, provided the cash value is within county approved burial limits. In that case, the life insurance is not cashed out, but ownership has been changed and if irrevocable, Medicaid does not view it as a countable resource. All other remaining resources, however then need to be within Medicaid limits.

Hope that helps.
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Gambler
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Re: See both financial advisor and elder law lawyer for Mom?

Post by Gambler »

She lives in NYC.

wow.. had no idea Medicaid facilities were that bad. Will talk to her about that.

but at the same time, there's good facilities that you pay 2yrs, then her pensions/SS check goes to the facility and that's it?
maybe that's what my mom is thinking of.
so a trust for her house and dad's stock? then withdraw and gift away the $300k 401k to me and my sister at $13k/yr each (or whatever the max is)?
And All 5 yr before entering the nursing home.

as for Long term care, I think the only company in NY is Lincoln Financial.
because of pro-consumer protection rules, most long term care companies avoid NY.

Also, if my mom had $0 assets but $72k/yr from pensions + ss, will she ever qualify for Medicaid?
and does it even matter if a good nursing home will accept $72k/yr after paying the full $120k/yr for 2yrs?

and lastly, why the elder law attorney first, THEN an independent financial advisor?


edit:
Mom turns 65 next year. When Medicare becomes her primary health insurance, she will have gap insurance (GHI) to pay for the remaining 20%.
(GHI is her current health insurance.)
"Always be thankful for what you have no matter how much or how little" -EternalOptimist
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BL
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Re: See both financial advisor and elder law lawyer for Mom?

Post by BL »

NY:
2014 limits:
Income $809/month
Resources $14,550
john94549
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Re: See both financial advisor and elder law lawyer for Mom?

Post by john94549 »

In the three+ years before she died, my Mom had private-pay in-home nursing. She needed neither a financial planner nor an elder-law attorney. What she did need was a reliable resource for the in-home care. A good starting point is always the nursing home. Elders who are on Medicare often wind up in a hospital, then are discharged for rehab to a nursing home. When Medicare (with input from the nursing home) determines the elder is ready for home, the nursing home will consult with the elder and son/daughter (etc.) and discuss options for in-home care. Professionals in the employ of said nursing homes are usually in a good position to make recommendations.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by bsteiner »

She can give away her assets, and then after 5 years get Medicaid.

The typical Medicaid trust is one in which she puts her assets into a trust in which she receives all the income, but can't ever get principal. If she does that, after 5 years, she can get Medicaid.

The principal tradeoff is that she would be giving up control and flexibility.

Also, given her assets and income, if she were to go into a nursing home (which probably wouldn't be for a while), her income would probably cover most of the cost, and if she were in a nursing home for a few years, and her assets were reduced by the shortfall, it wouldn't reduce her assets by very much.

So it's unlikely she would want to do this.

Note that if your father had provided for your mother in a trust that she could effectively control, she could have her cake and eat it, too. After 5 years, the assets she inherited from your father in trust would be protected if she ever wanted Medicaid, but she would effectively control the trust and could receive more than just the income.

Since it's less than 9 months since your father died, your mother may be able to disclaim some or all of your father's estate. If your father didn't leave his estate to your mother in a credit shelter trust, perhaps he created (in his Will) a disclaimer trust, so that any assets your mother disclaims would go into a trust for her benefit. She can't have the same degree of control over a disclaimer trust as she could have over a regular credit shelter trust, but it would still give her both Medicaid protection (after 5 years) as well as access to more than just the income.

Unless she creates the Medicaid trust (which most people in her situation, given her age and the amount of assets and income, would not create), this is more for a trusts and estates lawyer rather than an elder law (Medicaid) lawyer.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by celia »

Gambler wrote:. . .and lastly, why the elder law attorney first, THEN an independent financial advisor?
The elder law attorney will explain the Medicaid and other laws for her state and can help create/update a will, advanced health care directive ("living will"), power of attorney, medical power of attorney as LadyGeek mentioned. (The last 2 enable you or other people to make financial and medical decisions on her behalf if she is unable.)

THEN, once you understand NY law, you can determine how to pay for the things that will be needed or hire a financial planner to help you figure out where to pull the money from when the time comes.

Your mom needs to be involved in the legal decisions that only she can make if she is still competent. By also working with you on the financial end, she will learn why Medicaid is probably not what she wants and that, with her continuing income, she will probably be able to afford private pay care. Take a list of assets and their value to the consultation(s) along with any of the above documents she may already have. [They most likely need to be updated.]
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Re: See both financial advisor and elder law lawyer for Mom?

Post by Mitchell777 »

Arctic - Yes, that surely does help especially since we're in the same state. Thanks. Am I reading correctly that a pre paid funeral would not need to be cashed out? I'm assuming all individual stocks and bonds need to be sold off prior to applying for Medicaid but I fogot about the pre paid funeral. Also, would you suggest hiring an advocate when going through the Medicaid application process, whether using your elder law attorney or a patient advocate (vs relying only on the Admissions staff at a nursing facility to help you go through the process).
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Re: See both financial advisor and elder law lawyer for Mom?

Post by epitomist »

I wonder why it is that every one of my comments was removed as off topic but comments calling the OP a miscreant for his question were left fully intact?
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celia
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Re: See both financial advisor and elder law lawyer for Mom?

Post by celia »

epitomist wrote:I wonder why it is that every one of my comments was removed as off topic but comments calling the OP a miscreant for his question were left fully intact?
Epitomist, The OP was not called anything. The word referred to an anonymous caller to a radio show.

Your comments were quoted several times in following posts, so every time the original quote was deleted, it had to be deleted in all your quotes. Although we can no longer see what you wrote, I recall it had to do with trying to qualify for benefits for which the person wasn't qualified.

I see a big difference in taking advantage of the tax laws in order to minimize your taxes vs taking advantage of laws meant to help the poor. The tax laws are passed to ENCOURAGE people to spend/save their money in certain ways. Qualifying for poverty programs is meant to SCREEN OUT those who aren't the most needy.
A dollar in Roth is worth more than a dollar in a taxable account. A dollar in taxable is worth more than a dollar in a tax-deferred account.
epitomist
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Re: See both financial advisor and elder law lawyer for Mom?

Post by epitomist »

celia wrote:
epitomist wrote:I wonder why it is that every one of my comments was removed as off topic but comments calling the OP a miscreant for his question were left fully intact?
Epitomist, The OP was not called anything. The word referred to an anonymous caller to a radio show.

Your comments were quoted several times in following posts, so every time the original quote was deleted, it had to be deleted in all your quotes. Although we can no longer see what you wrote, I recall it had to do with trying to qualify for benefits for which the person wasn't qualified.

I see a big difference in taking advantage of the tax laws in order to minimize your taxes vs taking advantage of laws meant to help the poor. The tax laws are passed to ENCOURAGE people to spend/save their money in certain ways. Qualifying for poverty programs is meant to SCREEN OUT those who aren't the most needy.
My responses were defending the OP from people saying he is immoral and calling people who do what he was asking how to do a miscreant. You can split hairs all you want but he was being called a miscreant.

[OT comments removed by admin LadyGeek]
pshonore
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Re: See both financial advisor and elder law lawyer for Mom?

Post by pshonore »

I probably would not take the approach of trying to qualify for Medicaid myself, but as long as a person does it legally by transferring assets within the required time frame, establishing trusts, etc and not "hiding" assets, I don't see a problem. Is it very much different from a person who has say $1 million in assets, but limited current income and accepts an ACA subsidy? Is that ok? Or walking away from an underwater house/mortgage in a non-recourse state? Unfortunately, that's how the system is set up. I'd like to think I would not do any of those things, but others may.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by ChrisC »

Gambler wrote:She lives in NYC.

wow.. had no idea Medicaid facilities were that bad. Will talk to her about that.

but at the same time, there's good facilities that you pay 2yrs, then her pensions/SS check goes to the facility and that's it?
maybe that's what my mom is thinking of.
so a trust for her house and dad's stock? then withdraw and gift away the $300k 401k to me and my sister at $13k/yr each (or whatever the max is)?
And All 5 yr before entering the nursing home.

as for Long term care, I think the only company in NY is Lincoln Financial.
because of pro-consumer protection rules, most long term care companies avoid NY.

Also, if my mom had $0 assets but $72k/yr from pensions + ss, will she ever qualify for Medicaid?
and does it even matter if a good nursing home will accept $72k/yr after paying the full $120k/yr for 2yrs?

and lastly, why the elder law attorney first, THEN an independent financial advisor?


edit:
Mom turns 65 next year. When Medicare becomes her primary health insurance, she will have gap insurance (GHI) to pay for the remaining 20%.
(GHI is her current health insurance.)
I think you have a lot of homework to do! I suggest you and your mom become more knowledgeable about the medical care available for the elderly facing major medical issues. This could range from home care, independent living, assisted living, or skilled nursing care. I looked into this myself several years ago for my mom, with some guidance from a highly competent elder care lawyer (and my wife and I are both lawyers as well and we have family members in the health care profession). My mom has been in a skilled nursing care facility for the last 7 years and she is a Medicaid patient. We would have preferred her to be in a home care environment but she really needs 24-7 care in a skilled nursing facility. In NYC, the last time we looked, independent or assisted living facilities were generally "private pay" financed for patient care; in other words, they don't take Medicaid patients. (This is in contrast to some places we looked at in Virginia and North Carolina for my mother-in-law, where some of the "better" independent living or assisted living facilities will admit private pay patients and after they exhaust all their financial resources and become Medicaid eligible, will continue keeping these patients as Medicaid patients. In other others, they won't kick you out of the "better" facility after you spent your own funds at their facility and are now destitute and a Medicaid recipient. )

Many here have suggested that there are major differences in care between the skilled nursing care you might receive at a facility that takes Medicaid patients versus a facility that takes private pay patients. Well, there might be some skilled nursing facilities that take private pay patients only; I just never found one and perhaps others here know of one in NYC. One of the top rated facilities in NYC and the entire State takes both types of patients: http://cobblehilllifecare.org/CobbleHill/mission.asp. The difference in patient care in a nursing facility that has Medicaid and private pay patients might primarily evolve around room accommodations; I know that private pay patients can reside in a private room; Medicaid patients generally share a room with another patient.

Focus on the level of medical care your mom might need and then you can have a better idea of how to finance that level of care with your family's resources or with Medicaid assistance. A good elderly care lawyer would be a good place to begin educating yourself and your lawyer should be very knowledgeable about facilities in your area.
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Gambler
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Re: See both financial advisor and elder law lawyer for Mom?

Post by Gambler »

ChrisC,

thx for the recommendation on a nursing home.
what site did you use for ratings?
"Always be thankful for what you have no matter how much or how little" -EternalOptimist
ChrisC
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Re: See both financial advisor and elder law lawyer for Mom?

Post by ChrisC »

Gambler wrote:ChrisC,

thx for the recommendation on a nursing home.
what site did you use for ratings?
I think I used the State Health Department's ratings, recommendations from people in the field, and my sister and I actually visited several facilities. Not sure you quite understood the major thrust of my post: what type of current care or potential care do you and your mother think she needs? It seems you've shifted into high gear and assume that she needs skilled nursing care in a nursing home. As you posted, she's 64 and has arthritis (which many of us, including my wife and I at 63 and 61, have -- it's considered to be a byproduct of the aging process) -- yet this is hardly a basis to consider a nursing home even if the arthritis causes degenerative issues, as long as she's ambulatory. My mother entered a nursing home because she has dementia, congestive heart issues and a long history of mental illness. If we kept her in her home, she likely try to cook something and burn the house down!

While many of us will become cognitively impaired as we age, you don't indicate this is the case with your mother. The death of a spouse is very traumatic and perhaps your mother's thinking about nursing homes is impacted by the lost of your father -- she does not appear to be a good candidate for a nursing home at this stage of her life and perhaps for a long, long time. My mother-in-law is 95, with severe arthritic issues, replaced knees, and some mobility issues, and yet a nursing home would be an inappropriate fit for her -- she lives by herself for now (and will be moving in with us in the next few weeks), drives her own car, and shops by herself, but my mother-in-law and her family recognize that she cannot live by herself anymore -- as we age we all lose our balance and begin to fall and become less ambulatory -- and one bad fall can really mess you up when you're very old! My dad died a few months later after a fall when he was 86.

I suggest you and your mother plan for her to make the social, emotional, and financial adjustments caused by the death of your dad. Nursing homes should be last on your list of things to assess. I could see you and her looking at independent living residential facilities or downsizing her current residence, but this talk of a nursing home might be more grief related than sensible health, financial or legal planning.
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Re: See both financial advisor and elder law lawyer for Mom?

Post by Gambler »

so the apt for an elder law lawyer is later this month.
$200/hr, 2hr min
trust = $5000 :shock:

mom also mentioned pooled trust (http://www.ohelfamily.org and http://www.nysarc.com)??
she got the idea from one of her church friends. :oops:
"Always be thankful for what you have no matter how much or how little" -EternalOptimist
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